Paper short abstract:

The proposed paper exposes how public messaging as well as a set of social factors influenced health-seeking behaviors during the declining phase of the Ebola epidemic in Sierra Leone.

Paper long abstract:

At the end of January 2015, eight months after the official beginning of the Ebola epidemic in Sierra Leone and one year after the first case in West Africa, symptomatic individuals in Freetown still avoided the centralized triage and referral services. Moreover, once the initial symptoms had appeared, Ebola suspect cases opted for home treatment rather than seeking medical assistance from Ebola emergency medical services. Such services were only sought once the deterioration of health status was palpable. The patent incongruity between these behavioral patterns and the public health prescriptions promoted through social mobilization invites for an analysis of health-seeking behaviors' determinants in Sierra Leone.

The proposed paper demonstrates how health-seeking behaviors inconsistent with public health prescriptions were influenced by both social factors and public messaging. More precisely, it shows that negative perceptions of Ebola emergency services, the implementation of quarantine, as well as ambiguous health promotion messages concerning what to do after the appearance of symptoms, encouraged the avoidance of centralized triage and referral services. Similarly, denial and inadequate perceptions about Ebola symptoms as well as viral transmission contributed to the preference for home-based health care over the search for Ebola-specific medical assistance. On the contrary, active case finding and stigmatization reduced the opportunities for home-based health care of symptomatic individuals. In a similar way, the engagement of community leaders in the control of the outbreak via Ebola trainings boosted surveillance and the use of centralized triage and referral services.